Pharmacoeconomic analysis of ampicillin-sulbactam versus cefoxitin in the treatment of intraabdominal infections.
We conducted a retrospective pharmacoeconomic analysis of a prospective, multicenter, double-blind, randomized, controlled trial comparing the beta-lactamase inhibitor combination ampicillin-sulbactam (96 patients) and the cephalosporin cefoxitin (101) in the treatment of intraabdominal infections. An institutional perspective was adopted for the analysis. The primary outcomes of interest were cure and failure rates, development of new infection, and antibiotic-related adverse events. Epidemiologic data pertaining to outcomes was retrieved primarily from the trial, although results of other published studies were taken into consideration through extensive sensitivity analyses. Data pertaining to potential resource use and economic impact were retrieved mainly from the University Health Consortium and hospital-specific sources. When considering only costs associated with drug acquisition through cost-minimization analysis, a potential savings of $37.24/patient may be realized with ampicillin-sulbactam relative to cefoxitin based on an average 7-day regimen. Outcome data collected for the entire hospitalization during the trial revealed an approximately 9% greater frequency of failure with cefoxitin relative to ampicillin-sulbactam. When considering all outcomes of interest in the initial base-case analysis, a potential cost savings of approximately $890/patient may be realized with ampicillin-sulbactam relative to cefoxitin. In assessing the impact of the significant variability in probability and cost estimates, Monte Carlo analysis revealed a savings of $425/patient for ampicillin-sulbactam over cefoxitin (95% CI -$618 to $1516 [corrected]). Given the model assumptions, our analysis suggests a 78% certainty level that savings will be experienced when ampicillin-sulbactam is chosen over cefoxitin.
Messick
C R
CR
College of Pharmacy, University of Illinois at Chicago, 60612, USA.
Mamdani
M
M
McNicholl
I R
IR
Danziger
L H
LH
Rodvold
K A
KA
Condon
R E
RE
Walker
A P
AP
Edmiston
C E
CE
D018784:Abdominal Abscess / Q000188:drug therapy / Q000191:economics*; D000328:Adult; D000667:Ampicillin / Q000191:economics* / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D002440:Cefoxitin / Q000191:economics* / Q000627:therapeutic use; D002513:Cephamycins / Q000191:economics* / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D017046:Cost Savings; D004359:Drug Therapy, Combination; D004791:Enzyme Inhibitors / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D010406:Penicillins / Q000191:economics* / Q000627:therapeutic use; D010538:Peritonitis / Q000188:drug therapy / Q000191:economics*; D013407:Sulbactam / Q000191:economics* / Q000627:therapeutic use; D014481:United States; D065093:beta-Lactamase Inhibitors
D000900:Anti-Bacterial Agents; D002513:Cephamycins; D004791:Enzyme Inhibitors; D010406:Penicillins; D065093:beta-Lactamase Inhibitors; D002440:Cefoxitin; D000667:Ampicillin; D013407:Sulbactam